| NPI | 1770961765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA APRN-CRNA205056) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60560075) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2025-12-23 |